1. Rapid Effects of Inhaled Corticosteroids in Acute Asthma
Seventeen studies (470 adults and 663 children and adolescents) met the criteria for inclusion in this review of treatment with inhaled corticosteroids (ICS) within one to four hours of presentation of an asthma exacerbation. Final outcomes were admission and ED discharge rates. After the 2- to 4- hour protocol, a greater reduction of admission rate was observed in trials that used multiple doses of ICS, especially when compared with placebo (odds ratio{OR}, 0.30; 95% confidence interval {CI}, 0.16 to 0.55). ICS patients improve more rapidly when compared with placebo or systemic corticosteroids (SCS) increasing the probability of early ED discharge (OR 4.70; 95% CI, 2.97 to 7.42; p = 0.0001). Spirometric and clinical measures improved as early as 60 minutes with ICS. Benefits were obtained only when patients received multiple doses of ICS with ß-agonist compared with placebo or SCS. In conclusion, ICS used early in multiple doses administered in time intervals of < or = to 30 minutes over 90 to 120 minutes are especially beneficial. Editor's comment: High dose ICS plus ß-agonists used within four hours on multiple occasions for acute asthma effectively decreases morbidity from severe asthma exacerbations. Rodrigo GJ, Chest 2006; 130: 1301

2. Effects of Continuing or Stopping Alendronate (A) After 5 Years of Treatment
One thousand and ninety-nine (1099) postmenopausal women with a mean of five years of prior A treatment were randomized to A, 5 mg/d (n = 329) or 10 mg/d (n = 333), or placebo (P) (n = 437) for five years. Compared with A, switching to P resulted in declines in bone mineral density (BMD) at the total hip (P< .001) and spine (P<.001), but mean levels remained at or were above pretreatment levels 10 years earlier. The cumulative risk for nonvertebral fractures was not significantly different between the two groups. Those on A had significantly lower risks of clinically recognized vertebral fractures (5.3% for P, 2.4% for A) but no significant reduction in morphometric vertebral fractures (11.3% for P, 9.8% for A). The authors suggest that the discontinuation of A after five years does not significantly increase the fracture risk, however, women at high risk of clinical vertebral fractures may benefit by continuation of A. Editor's comment: Physicians who treat asthma and allergic and immunologic diseases need to know how to diagnosis and treat osteopenia and osteoporosis. SG. Black DM, et al. JAMA 2006; 296: 2927. Editorial, Colón-Emeric C. JAMA 2006; 296: 2968.

3. Long-Term Proton Pump Inhibitor (PPI) Therapy and Risk of Hip FractureThis is a nested, case-control study using a research database from the United Kingdom. The cohort consisted of users of PPI therapy versus nonusers of acid suppression drugs older than 50 years. Similar nested, case-control analysis for histamine 2 receptor antagonists was performed. The adjusted odds ratio (AOR) for hip fractures associated with more than one year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). For long-term high dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The risk increased with duration of PPI therapy, i.e., up to four years. The authors conclude that PPI therapy significantly increases the risk of hip fracture, possibly secondary to acid suppression and decreased calcium absorption. Editor's comment: The risk-benefit of PPI therapy needs to be considered. Individuals with asthma commonly have gastroesophageal reflux disease. Using the lowest effective PPI dose and increasing consumption of dairy products, calcium supplements with meals, and vitamin D therapy make sense. Yang Y-X, et al. JAMA 2006; 296: 2947.

To read the additional reviews, click here.
WAO Now: What's New in the World of WAO

World Allergy Forum
"A Global Perspective on Genetics, the Environment and Allergy"

The WAO Henning Løwenstein Research Award 2007Call for Applications
The WAO Henning Løwenstein Research Award is a biennial award given to a young scientist who has shown excellence within the field of allergy. WAO and ALK-Abelló will present the award at the World Allergy Congress in Bangkok, 2-6 December 2007.

The winner will receive EURO 20,000 together with a travel grant to attend the Congress.

For application guidelines visit www.alk-abello.com and click on "The WAO Henning Løwenstein Research Award."

Deadline: 30 June 2007

New Synopsis
Drug Allergies are the focus of the latest educational synopsis to be posted on the WAO Web site. Written by Bernard Thong, MBBS, MRCP (UK), FAAAAI, with contributions from Cassim Motala, MD FCPAED(SA) FACAAI FAAAAI , and Daniel Vervloet, MD FAAAAI, the synopsis provides a comprehensive overview of immunological and non-immunological adverse drug reactions. To read this new synopsis in WAO's Allergic Diseases Resource Center, click here.

WAO Conversations:
We have the pleasure of announcing four new interviews with well-respected allergists. Take a moment to listen to them sharing their extensive knowledge.

Prof. Stephen Durham - Mechanisms of Immunotherapy

Dr. Thomas Platts-Mills - Indoor Allergen Control

Prof. Carlos Baena-Cagnani - History and Vision of the World Allergy Organization

Dr. Harold Nelson - How do you properly mix Allergen Vaccines?

El-Ghoneimy Short-Term Fellowship Report
Dr. Dalia El-Ghoneimy from Cairo, Egypt, spent her WAO Short-Term Research Fellowship in the laboratory of Prof. G. Walter Canonica in Genoa, Italy, studying skin prick testing in the early diagnosis of atopy in infants and children and immunotherapeutic modalities. The objective of her fellowship was to receive the necessary training to enable her to identify the major allergens to which infants in Egypt are sensitized and the possible immunotherapeutic interventions needed. To read Dr. El-Ghoneimy's report on her fellowship, click here.

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NOTE: The book, Allergy in Practice, was reviewed by two different reviewers, as follows.

First review of Allergy in Practice
Reviewer: Ron Purcell, MD
University of South Florida College of Medicine and James A. Haley
Veterans Hospital, Tampa, FL, USA

Description:Allergy in Practice is a concise yet remarkably thorough overview of allergic disease and provides the reader with a basic understanding of the physiology, diagnosis, and treatment of commonly encountered allergic conditions. This is an updated version of the 2nd edition printed in 1988 and reflects the many changes in the field over the past 20 years.

Purpose:
This book is written to provide the reader with a better understanding of the recognition and treatment of allergic diseases commonly encountered in the clinical setting. It does not cover immunodeficiency, rheumatology or other immunologic conditions except as they relate specifically to allergy.

Audience:
Medical students, physicians in training, and other health care professionals looking for an introduction to the clinical practice of allergy will find this to be an excellent resource. It also serves well as a reference for health care professionals who want rapid access to clinically useful information regarding the field of allergy.

Features:
Without a doubt, the book's strong point is the author's exceptional ability to present information in a concise, straightforward manner. Despite being only 276 pages and measuring 25 X 17 cm, the book covers nearly every aspect of allergy in such a way that the reader can quickly grasp even difficult concepts. Each section is clearly delineated and rarely exceeds two pages; many are only one or two paragraphs. Despite this brevity, explanations are thorough and complete. The clinical sections are organized logically and make generous use of tables, so differential diagnosis, common physical findings, and other practical information can be quickly accessed. Extensive cross referencing of sections allows the reader to easily locate related concepts or conditions. Additional chapters covering allergen immunotherapy and diagnostic techniques, such as skin testing, provide insight into how these are accomplished by specialists trained in these procedures.

Assessment:
Anyone wishing to increase their understanding of the diagnosis and management of allergic disease in a concise, readable format will find this to be an excellent resource.

Second review of Allergy in Practice
Reviewer: Salvador Gala, MB BS PhD
University of Sydney

Description:
Prof. Ring states his book evolved from a series of information leaflets and short chapters for residents rotating through his Allergy Division. Thus, the underlying theme reflecting a detailed but concise introduction to allergic disease is evident throughout Allergy in Practice. There are the standard chapters on allergic mechanisms, clinical evaluation, diagnostic tests and therapy. However, grouping of allergic disorders within the main body of the text is predominantly according to the Gell and Coombs classification, wherein clinical information appears within a scheme of pathophysiology. Nevertheless, this approach works quite well; the reviewer was easily able to navigate throughout the different subsections of the book when searching for specific pieces of information. As the sole author, Prof. Ring eschews those problems of excess, irrelevant detail and redundancy so commonly observed in multi-authored comprehensive texts.

Purpose:Allergy in Practice provides the trainee and non-specialist reader with a detailed but concise introduction to the field of allergy. Prof. Ring covers all major subject areas relevant to the basic science and clinical management of allergic disease. It is, in essence, a textbook - but written in a user-friendly style.

Audience:
Whilst easy to follow, Allergy in Practice is pitched at the specialist level. This book is, therefore, ideal as a study aid for allergy trainees and residents undertaking an allergy rotation and as a refresher for allergy specialists. Non-allergist physicians requiring specific information on allergic disorders will more readily find answers here, rather than trying to negotiate larger comprehensive allergy texts.

Features:
The positive qualities to Allergy in Practice are plentiful. Descriptions of individual allergic disorders are detailed but concise. Those aspects of basic science chosen for review are all clinically relevant. High-quality color photography is included throughout the book to demonstrate important clinical, radiological and histological points within the main text. Prof. Ring makes frequent use of schematic multi-color diagrams to convey important concepts without, however, becoming entrenched in overly complicated detail. Lists and tables accompanying the text are useful for clinical reference because they achieve a balance between sufficient detail and conciseness. References are very selective and included on the basis of clinical relevance.

Does the book have any drawbacks? Its advantages are at the same time its limitations. The reader will still need access to comprehensive textbooks and journals for details of rare conditions, in-depth reviews, and more up-to-date information. Inclusion of an Appendix serves to partly address these issues by directing the reader towards additional sources of information.

Assessment:
Prof. Ring's publication represents a clinically useful, high-quality 'entry-level' allergy textbook. As summarized by Prof. Platts-Mills in his foreword to Allergy in Practice, Prof. Ring provides a comprehensive but well planned description of allergic disorders "that are either very common or just common." Allergy in Practice is designed for use as an introductory textbook, to be studied cover-to-cover and complemented by reading of current literature.

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